扩大的腹主动脉旁淋巴结清扫可改善Bismuth Ⅰ/II型肝门部胆管癌患者术后生存

doi:10.3969/j.issn.1672-5069.2018.05.027

摘要/Abstract

摘要： 目的淋巴结转移是肝门胆管癌一种主要的不良预后因素。肝门部淋巴首先流向胆总管旁淋巴结,之后流向胰头上后淋巴结,以及门静脉和肝总动脉旁淋巴结,并可通过肝总动脉淋巴结、胰后淋巴结或直接转移至腹主动脉旁淋巴结。目前,对于Bismuth I/II型肝门胆管癌患者的常规根治性切除术中包括了对肝门部（主要是肝十二指肠韧带周边）淋巴结的清扫,但是否应增加对腹主动脉旁淋巴结的清扫,以及其对患者预后的影响尚无研究。方法 2005年~2009年在我院行根治性切除术治疗的72例I/ II型肝门部胆管癌患者,在切除肿瘤的同时,35例患者在对肝门区域淋巴结清扫的同时,将胰结肠韧带切开,暴露腹主动脉,对腹主动脉旁淋巴结进行清扫,另37例未清扫。结果与37例未行腹主动脉旁淋巴结清扫患者比,35例进行了清扫的患者1 a、2 a和3 a肿瘤复发率分别为22.9%、40.1%和65.7%,均明显低于未清扫组的45.9%、62.2%和91.9%（P<0.05）,无进展生存率分别为65.7%、40.0%和17.1%,总生存率分别为74.3%、60.0%和31.4%,均明显高于未清扫组（分别为35.1%、16.2%和2.7%和59.5%、40.5%和13.5%,P值均<0.05）。结论腹主动脉旁淋巴结清扫可降低Bismuth I/II型肝门部胆管细胞癌患者术后肿瘤复发率,延长患者生存期。

关键词: 肝门部胆管癌, 腹主动脉旁淋巴结清扫, 生存率

Abstract: Objective Lymph node（LN） metastasis is a major negative predictive factor for hilar cholangiocarcinom （HC）. Whether clearance of abdominal aortic LN can influence progression free survival （PFS） and overall survival （OS） in Bismuth type I and II HC has not been well evaluated. Methods We retrospectively reviewed the data of 72 patients with Bismuth type I and II HC admitted to our hospital undergoing surgical resection with curative intent between 2005 and 2009. Results Compared to 37 HC patients without clearance of abdominal aortic LN,35 patients with clearance of abdominal aortic LN demonstrated a significantly lower 1,2 and 3 a tumor recurrence rate（22.9%,40.1% and 65.7% vs. 45.9%,62.2% and 91.9%,respectively,P<0.05）;PFS were 65.7%,40.0% and 17.1,and OS were 74.3%,60.0% and 31.4%,both much higher than in patients without clearance of abdominal aortic LN（35.1%,16.2% and 2.7%,and 59.5%,40.5% and 13.5%,respectively,all P<0.05）. Conclusions Clearance of abdominal aortic LN could reduce the recurrence of tumor and improve PFS and OS in patients with type I and II HC after surgical operation.

Key words: Type I and II hilar cholangiocarcinoma, Clearance of abdominal aortic lymph nodes, Survival rates

孟令军, 张晓荣, 杨保金. 扩大的腹主动脉旁淋巴结清扫可改善Bismuth Ⅰ/II型肝门部胆管癌患者术后生存[J]. 实用肝脏病杂志, 2018, 21(5): 761-764.

Meng Lingjun, Zhang Xiaorong, Yang Baojin.. Abdominal aortic lymph node clearance improves progression-free and overall survival in patients with type I and II hilar cholangiocarcinoma[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(5): 761-764.

参考文献

[1] Zhimin G,Noor H,Zhou JB,et al.Advances in diagnosis and treatment of hilar cholangiocarcinoma:a review.Med Sci Monit,2013,19:648-656.
[2] 薛源,苏继荣.肝门部胆管癌的诊断与外科治疗.中国现代药物应用,2013,7(1):19-21.
[3] Soares KC,Kamel I,Cosgrove DP,et al.Hilar cholangiocarcinoma:diagnosis,treatment options,and management. Hepatobiliary Surg Nutr,2014,3(1):18-34.
[4] Valls C,Ruiz S,Martinez L,et al.Radiological diagnosis and staging of hilar cholangiocarcinoma. World J Gastrointest Oncol,2013,5(7):115-126.
[5] 谭福勇. 肝门部胆管癌外科手术治疗的进展. 医学综述,2012,6(18):1863-1866.
[6] 周宁新,黄志强,张文智,等. 402例肝门部胆管癌临床分型、手术方式与远期疗效的综合分析. 中华外科杂志,2006,44(23):1599-1603.
[7] Castellano-Megías VM,Ibarrola-de Andrés C,Colina-Ruizdelgado F. Pathological aspects of so called “hilar cholangiocarcinoma”. World J Gastrointest Oncol,2013,5(7):159-170.
[8] Kitagawa Y,Nagino M,Kamiya J,et al.Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection. Ann Surg,2001,233(3):385-392.
[9] Mantel HTJ,Wiggers JK,Verheij J,et al.Lymph node micrometastases are associated with worse survival in patients with otherwise node-negative hilar cholangiocarcinoma. Ann Surg Oncol,2015,22:1107-1115.
[10] Prognostic factors for progression-free and overall survival in advanced biliary tract cancer. Ann Oncol,2015,46(1):1-7.
[11] Bekaii T,Phelps MA,Li X,et al.Multi-institutional phaseⅡ study of selumetinib in patients with metastatic biliary cancer .J Clin Oncol,2011,29(17):2357-2363.
[12] Koerkamp G,Wiggers JK,Allen PJ,et al.Recurrence rate and pattern of perihilar cholangiocarcinoma after curative intent resection. J Am Coll Surg,2015,221(6):1041-1049.
[13] Guglielm A,Ruzzenente A,Campagnaro T,et al.Prognostic significance of lymph node ratio after resection of peri-hilar cholangiocarcinoma. HPB,2011,13:240-245.
[14] Ruys AT,Ten Kate FJW,Busch OR,et al.Metastatic lymph nodes in hilar cholangiocarcinoma:does size matter. HPB,2011,13:881-886.
[15] Mao K,Liu J,Sun J,et al.Patterns and prognostic value of lymph node dissection for resected perihilar cholangiocarcinoma. J Gastroenterol Hepatol,2016,31(2):417-426.
[16] 刘振国,强永乾. 螺旋CT 和MRI 对肝内周围型胆管癌诊断价值分析. 实用肝脏病杂志,2016,19(5):591-594.
[17] Koerkamp G,Wiggers JK,Allen PJ,et al.Recurrence rate and pattern of perihilar cholangiocarcinoma after curative intent resection. J Am Coll Surg,2015,221(6):1041-1049.
[18] Amitcohen BC,Rahat MM,Rahat MA.Tumor cell macrophage interactions increase angiogenesis through secretion og EMMMPRIN. Front Physiol,2013,12(4),178-183.
[19] Bekaii T,Phelps MA,Li X,et al.Multi-institutional phase Ⅱ study of selumetinib in patients with metastatic biliary cancer. J Clin Oncol,2011,29(17):2357-2363.
[20] 易为民,彭创,厉鸥,等. 胆管细胞癌细胞CD147表达及其临床意义. 实用肝脏病杂志,2017,20(11):97-100.